If you're considering prescription weight loss medication in Canada, two names keep coming up: Contrave and Ozempic. These medications work in completely different ways, have different costs, and produce different results. The right choice depends on your health profile, your budget, and what your doctor recommends.

How They Work: Two Very Different Mechanisms

Contrave is an oral medication (pills taken twice daily) that combines two drugs: naltrexone and bupropion. Naltrexone is typically used to treat opioid and alcohol dependence. Bupropion is an antidepressant also prescribed for smoking cessation. Together, they target the reward centers in your brain to reduce cravings and appetite.

Ozempic (semaglutide 1 mg) is a once-weekly injection. It mimics a gut hormone called GLP-1 that tells your brain you are full. It also slows gastric emptying, so food stays in your stomach longer. Ozempic was originally approved for type 2 diabetes, but doctors prescribe it off-label for weight loss across Canada. For more on how semaglutide works, see our semaglutide guides page.

The bottom line: Contrave works on your brain's reward system. Ozempic works on your gut hormones and appetite signaling. They are fundamentally different drugs.

Effectiveness: How Much Weight Can You Lose?

I reviewed the published clinical trial data for both medications. The difference is significant.

Contrave (COR-I trial): Participants lost an average of 5 to 6% of their body weight over 56 weeks. About 42% of patients lost at least 5% body weight, compared to 17% in the placebo group.

Ozempic (STEP 1 trial, 2.4 mg semaglutide): Participants lost an average of 14.9% of their body weight over 68 weeks. About 86% lost at least 5% body weight, and roughly one-third lost 20% or more.

That's roughly three times the weight loss with semaglutide compared to Contrave. However, individual results vary widely. Some people respond very well to Contrave, especially those who struggle with food cravings and emotional eating.

Cost Comparison in Canada

Cost is often the deciding factor for Canadians. Here is what I found when I researched pharmacy prices in early 2026.

| Factor | Contrave | Ozempic (1 mg) |

|---|---|---|

| Monthly cost (no insurance) | $130 to $170 | $300 to $500 |

| Administration | Oral (pills, twice daily) | Injection (once weekly) |

| Generic available | Yes (Dr. Reddy's + Apotex, May 2026) | No (still patent protected) |

| Costco price | ~$140/month | ~$300/month |

| Annual cost estimate | $1,560 to $2,040 | $3,600 to $6,000 |

Contrave is roughly half the price of Ozempic. For detailed Ozempic pricing, see our Ozempic at Costco price breakdown.

Generic Semaglutide at In-Person Canadian Pharmacies

Cash retail prices for generic semaglutide at Canadian pharmacies are now coming in below the telehealth alternatives, based on early Canadian consumer reports. Costco Pharmacy is the lowest reliable option at roughly $88 to $99 per month (confirmed pickups: $88.88 GTA, $88 Ontario, $99 Laval, $91 Medicine Hat). Walmart and Loblaws No Frills typically come in around $95 to $110 per month. Shoppers Drug Mart, Rexall and London Drugs are running roughly $100 to $120 per month (one Halifax-area Shoppers fill reported $113 for the 0.25mg starter dose). Apotex's Apo-Semaglutide Injection began shipping to Canadian pharmacies on May 20, 2026, with Dr. Reddy's generic also launching in May 2026.

That makes in-person pharmacies — especially Costco — meaningfully cheaper than telehealth providers for generic semaglutide. Felix Health and Hims Canada both list $149 per month all-in for the same generic Apo-Semaglutide on their public pricing pages. For most Canadians with a valid prescription, walking it into a local pharmacy is now the cheapest reliable path.

Pricing context: per the Globe and Mail, Apotex's published wholesale price is $78.14 for a four-week supply — roughly one-third of brand-name Ozempic's $240.48 wholesale price. Retail estimates above reflect that wholesale plus each chain's standard dispensing fee and markup. See also coverage from CBC News on the Canadian launch. Under the pan-Canadian Pharmaceutical Alliance framework, the maximum public drug plan price for generic semaglutide is approximately $114 per four-week supply with two manufacturers approved, dropping to roughly $80 once a third manufacturer launches.

Side Effects Comparison

Both drugs cause side effects, but the profiles are quite different.

| Side Effect | Contrave | Ozempic |

|---|---|---|

| Nausea | Common (30%) | Very common (40%+) |

| Constipation | Common (18%) | Common (15%) |

| Headache | Common (18%) | Less common |

| Diarrhea | Less common | Common (30%) |

| Vomiting | Less common | Common (20%) |

| Insomnia | Common | Rare |

| Dry mouth | Common (8%) | Rare |

| Pancreatitis risk | Not reported | Rare but documented |

| Seizure risk | Yes (dose-dependent) | No |

Contrave carries a seizure warning. It should not be used by anyone with a seizure disorder or eating disorder (bulimia or anorexia). Ozempic carries a thyroid C-cell tumor warning based on rodent studies, though this has not been confirmed in humans.

Most GI side effects with Ozempic improve after the first four to six weeks. Contrave side effects like nausea and headache also tend to ease as the dose is gradually increased over the first month.

Insurance Coverage in Canada

Coverage varies by province, but there are some general patterns I found across the country.

Contrave: Most provincial drug plans do not cover Contrave. CADTH (now CDA-AMC) recommended against public reimbursement in 2021, citing modest efficacy relative to cost. Some private insurers cover it with prior authorization from your doctor. Check your plan's formulary.

Ozempic: When prescribed for type 2 diabetes, Ozempic is covered by most provincial formularies and many private plans. When prescribed off-label for weight loss only, coverage is much less likely. Most provinces will not reimburse it without a diabetes diagnosis. Some employer-sponsored plans will cover it for weight management if your doctor submits documentation.

If you do not have private insurance, both medications are out-of-pocket expenses for most weight loss patients in Canada.

Which Should You Choose?

Based on my research, here is how I'd frame the decision.

Contrave may be better if:

  • You want to avoid injections entirely
  • Your budget is tight (roughly half the cost of Ozempic)
  • Emotional eating or food cravings are your main struggle
  • You also want help with smoking cessation (bupropion has that benefit)
  • You have a moderate amount of weight to lose (10 to 20 lbs)

Ozempic may be better if:

  • You need to lose a significant amount of weight (30+ lbs)
  • You have type 2 diabetes or prediabetes (Ozempic treats both)
  • You prefer once-weekly dosing over twice-daily pills
  • You have cardiovascular risk factors (semaglutide has demonstrated heart benefits)
  • Your insurance covers it for diabetes

One cost update: the old rule that Contrave is roughly half the price of Ozempic no longer holds. Since May 2026, generic semaglutide (the Ozempic molecule) runs about $88 to $99 per month at Costco Pharmacy, so the price gap between the two is much smaller than it used to be. See our generic semaglutide guide.

Your doctor is the right person to make this call with you. Bring your questions. If you want to explore getting a prescription online, our how to get Ozempic in Canada guide walks through the process.

Can You Take Contrave and Ozempic Together?

There is no Health Canada approved protocol for combining Contrave and Ozempic. Some doctors in the US have experimented with combination therapy, but there are no published clinical trials supporting this approach.

The nausea risk would likely be severe if both drugs were used simultaneously, since both suppress appetite through different pathways. Taking both would also mean paying for two medications, pushing monthly costs above $500.

I would not recommend this without explicit guidance from your prescribing physician. If one medication isn't working, switching to the other (rather than stacking) is the standard medical approach.

Frequently Asked Questions

Is Contrave as effective as Ozempic for weight loss?

No. Clinical trials show Ozempic (semaglutide) produces roughly 15% body weight loss on average, while Contrave produces about 5 to 6%. Ozempic is approximately three times more effective by this measure. That said, Contrave works well for some patients, especially those whose weight gain is linked to cravings and reward-driven eating.

Do I need a prescription for Contrave in Canada?

Yes. Both Contrave and Ozempic are prescription-only in Canada. You can get a prescription through your family doctor, an endocrinologist, or through telehealth platforms like Felix Health or Maple.

Can I switch from Contrave to Ozempic?

Yes. Many patients try Contrave first because of its lower cost. If results are insufficient after three to six months, your doctor may switch you to semaglutide. There is no required washout period between the two, but your doctor will want to taper you off Contrave's bupropion component gradually to avoid withdrawal effects.

Further Reading

For more on how semaglutide works and its clinical evidence, read our complete guide to semaglutide in Canada. To compare with another injectable option, see our Mounjaro in Canada guide. For step-by-step prescription instructions, check how to get Ozempic in Canada.

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